By May 2002, personal trainer and triathlete Jaime Powell had been enjoying a vigorous Ashtanga Yoga routine for three years. But that spring her practice was transformed in an instant when a truck hit her while she was out on her bike for a training ride, breaking two of her ribs, chipping two vertebrae, fracturing her sternum, and badly injuring her knee.
It was more than a year before Powell could return to her Ashtanga practice, and going from having a body that could bend like a pretzel to one that had to rely on a walker for two months permanently altered her approach to yoga. "The accident helped me become much less competitive," she says, "more self-reflective and tuned in to subtleties. I realized that being present and patient and slowly working an edge is the same for everyone, regardless of physical ability."
With luck, few of us will face such a life-threatening event. But nearly everyone will eventually encounter some health challenges less dramatic accident, a tweaked back or knee, a chronic condition, the vagaries of growing older that temporarily or permanently alters our asana practice.
For some, this shift in abilities is gradual, as it has been for Wyoming resident Barbara Gose, a 65-year-old retired professor of political science whose arthritis has made practicing many familiar poses increasingly difficult and painful. Others, like Eric Small, may find themselves turning to yoga for help after the onset of an illness. Diagnosed with multiple sclerosis at age 21, Small was told he probably wouldn't live to 40. Now a muscular, vigorous man in his mid-70s, Small credits Iyengar Yoga with keeping his MS at bay. He holds a Senior Level II Iyengar teaching certificate and has been teaching the practice to other students with physical challenges for decades.
COME TO THE MAT
As Powell, Gose, and Small have discovered, physical challenges don't need to end your yoga career or prevent you from developing one even if you've never practiced before. Yoga is infinitely malleable and can be adapted to benefit everyone from the young, fit, and able-bodied to elders with arthritis, from students with temporary injuries to paraplegics in wheelchairs and people who are permanently bedridden.
Medical research has documented yoga's benefits for some special-needs populations. Researchers at Oregon Health & Science University found that older adults and people with multiple sclerosis who participated in a weekly yoga class and home practice for six months showed significant improvement in measures of fatigue compared to a control group that didn't practice yoga. "We also demonstrated improvements in forward bending and one-legged standing ability," says neurologist Barry Oken, M.D., who has practiced yoga for 15 years. Such improvements are especially valuable for seniors, since fractures resulting from falls are a leading cause of disability among older adults.
Better posture is another plus, says Julie Lawrence, an Iyengar-certified instructor who collaborated with colleague Jane Carlsen to create the yoga class used in the Oregon study. "Slumping constricts the internal organs and interferes with respiration, circulation, and digestion," says Lawrence. "Good alignment helps people breathe better, which has a calming effect on the entire body." Also, she says, just as slumping can reflect and magnify a downbeat emotional state, so good alignment can help you feel more cheerful and energetic.
Yoga's ability to help stooped seniors stand taller was demonstrated in a recent study of older women with hyperkyphosis (a.k.a. dowager's hump). Research by Gail Greendale, M.D., of the University of California, Los Angeles, found that one-hour yoga sessions twice a week for 12 weeks helped participants increase their height, reduce the forward curvature of their spines, and improve their scores on physical tests that assessed everyday
tasks like walking, rising from a chair, and reaching for an object in front of them. Participants also said the yoga helped reduce pain, improve breathing, and increase endurance. "More than 60 percent reported increased feelings of well-being," says Greendale.
Although Western scientists are just beginning to study yoga's potential to alleviate many chronic health conditions, a large number of practitioners swear it's made a huge difference in their lives. Some are like Eric Small, who's continued to thrive for 35 years longer than his doctors expected him to live. Others, like Gose, credit it with helping them build and maintain strength, flexibility, and balance. And countless practitioners, like Jaime Powell, have used yoga to help them maintain physical and emotional strength and rehabilitate after injuries and accidents.
LET FORM FOLLOW FUNCTION
Whether you're a brand-new or a longtime yogi, your practice may look quite different from the classic poses if you have significant physical limitations. Fortunately, the underlying principles of yoga are more important than the formsand those principles are the same for everyone, whether a person is an Olympic athlete or in a wheelchair, says Gary Kraftsow, founding director of the American Viniyoga Institute and author of several books, including Yoga for Wellness (Penguin, 1999). The core idea, he says, is to mobilize the spine safely, using the breath, in five main directions: bending forward, backward, and sideways; twisting; and lengthening the spine. The first step, says Kraftsow, is to assess what is safe and possible in each of these movements. "Then you can build upon that base."
This usually requires breaking down complex poses into their most basic parts. If you've been hunched over for years, for example, simply lifting your chest up and away from your navel can stretch your belly and act as a backbend. Conversely, says Kraftsow, the most basic piece of a forward bend involves contracting the abdominal muscles on your exhalation to provide a gentle stretch for the lower back.
FIND A GUIDE
If you're a longtime practitioner, you may be able to figure out how to change your poses to accommodate a new limitation. But it can be both emotionally and intellectually challenging to venture into new territory, so you may find it useful to work with an instructor who has experience teaching students with special needs. If you're brand new to yoga, this kind of teacher can be invaluable.
If you're injured or sick or have other physical limitations, you need to "start where you are and let go of any image of what you should look like in a pose," says Vandita Kate Marchesiello, who directs the Kripalu Yoga Teachers Association and teaches yoga for special populations. She recommends taking an "adaptive," "therapeutic," or "gentle" yoga class. (For more information, see "Class Cues," end of article.) Teachers offering such classes often use props like chairs, blocks, bolsters, blankets, and straps to modify postures; what's more, says Marchesiello, "the classes also foster a sense of support and community."
REMEMBER TO BREATHE
"The breath is the most important part of the pose," says Swami Sarvaananda, who teaches Deergha Swaasam (Three-Part Breath) to students in her Gentle Yoga classes at the Integral Yoga ashram in Buckingham, Virginia. (For instructions, see "Breathing Lessons" at the end of this article.) If her students find an asana too difficult, Sarvaananda suggests they simply breathe and visualize the pose.
Mukunda Stiles, director of the Yoga Therapy Center in Boulder, Colorado, and author of Structural Yoga Therapy (Weiser Books, 2000), echoes Sarvaananda's emphasis on the breath. Learning to breathe deeply and move with the breath is crucial, he says, whether you're lifting just one pinkie finger or your entire bodyand it's especially crucial in adaptive, therapeutic practice.
Students dealing with chronic aches and pains can use the breath to ease discomfort. "I breathe into my hip whenever I feel a catch in it, and my arthritis pain melts away," says Gose, who thinks yoga and breathing have helped her cut back on pain medication.
TAKE IT TO THE FLOOR
Of course, we all come to yoga with different sets of issues, but for many people, especially older students, one of the hardest things is getting up and down from the floor. "Helping students sit and lie down on the floor is often the most important part of their first lesson," says Suza Francina, a certified Iyengar Yoga instructor in Ojai, California, and author of The New Yoga for People over 50 (Health Communications, 1997). "Practicing getting up and down from the floor is valuable because it helps with other essential independent living skills like getting up and down from chairs and the toilet," she says.
If you're still fearful and unsure of your ability, try holding on to a sturdy, stable chair placed on top of a yoga mat and braced securely against a wall. Use a folded yoga mat near the chair to pad the floor and make kneeling more comfortable. When Francina teaches older students, she stands nearby to make sure they don't fall. "If the students are having a hard time, I encourage them to try their other side to see if it's stronger." She also encourages them to take all the time they need to come to the floorand to rest as long as they need before trying to get back up. "As with anything else," she says, "it gets easier with practice. I constantly remind my older students to sit on the floor every day." If your yoga teacher isn't comfortable helping you with these skills, Francina suggests working with an occupational or physical therapist.
If it's impossible to get down on the floor, don't worry about it: You can do a complete practice on a chair. Mary Cavanaugh, an 83-year-old yoga teacher who began practicing in her mid-40s to heal back pain exacerbated by factory work during World War II, created a DVD set (Secrets to Feeling Better) that includes a modified Sun Salutation done on a chair. For would-be yogis with even less mobility, the DVD also includes a practice you can do in bed. (Cavanaugh died this year. For a brief biographical note and review of her other CD, Secrets to a Long and Healthy Life, see page 115 of the May/ June 2005 issue of Yoga Journal.)
FIVE YOURSELF PROPS
Whether your difficulties involve strength, endurance, stability, mobility, flexibility, or postural challenges, the primary solution is similar: Modify the traditional poses, using props if necessary, so you can safely perform their key actions. Props can make it easier to practice every type of pose.
If unsupported standing poses are too challenging, you can practice them with your back against a wall or by holding on to a chair. If the poses feel too difficult even with these modifications, you can lie on the floor on your back and practice them with your feet on a wall.
If you have a rounded spine and find just lying facedown to be a fairly strong backbending action, the floor may be the only prop you need. If you can move into a somewhat stronger (but still passive) backbend, lie faceup with your back gently arched over a bolster or tightly rolled blanket; keep your legs straight or, to protect your lower back against compression, bend your knees and keep your feet flat on the floor.
If seated postures are uncomfortable because of stiff hips and hamstrings, sitting on a bolster or folded blankets can help you lift through your spine and open your chest. If your lower back still slumps, sit with your back against a wall for extra support. In seated twists, place your hands against a wall or a heavy piece of furniture for more stability and leverage. In seated forward bends, use straps to bridge gaps between your hands and feet, and support your upper body with bolsters or folded blankets, or by placing your arms on a chair. If you can't reach the floor in standing forward bends, put your hands on yoga blocks or a stable piece of furniture.
Even the basic inverted posture Viparita Karani (Legs-up-the-Wall Pose) is possible with props. If swinging your legs up the wall is too difficult, rest your lower legs
on a chair seat for an easier version. In fact, even if you're bedridden you can create a similar position by propping your legs up on bolsters or cushions.
Finally, props can give you the full restorative benefits of Savasana (Corpse Pose) by maintaining the natural curves of the spine and making you as comfortable and relaxed as possible. (For information on propping restorative poses, consult Judith Hanson Lasater's book Relax and Renew, Rodmell Press, 1995.)
FACE YOUR FEARS
Yoga can do much more than give you physical strength; it can also help you heal emotional wounds.
One of the most powerful limitations to starting or restarting a yoga practice can be your own fear. If you've suffered an accident or confronted a serious illness, you may be so traumatized that you're afraid to be fully present in your body, says Maria Mendola, a registered nurse in Tucson, Arizona. Mendola knows this dynamic intimately; eleven years ago, she broke her back, and she says letting go of fear in her body and mind took more than five years. Now certified in Integrative Yoga Therapy, Mendola addresses her students' fears not just physically but also emotionally. "To help with a fear of falling, for instance, I teach them to establish a firm base," she says, "but I also encourage them to formulate positive intentions like 'I am becoming stronger and more stable' and 'I am healing.' This influences the subconscious and can have a profound effect."
Viniyoga teacher Kraftsow also stresses the mental benefits. "It can transform
the mind," he says. "Much of its healing power is rooted in its ability to nourish self-confidence and help you see your potential and overcome a sense that you're limited." Feelings of anxiety and depression may ease as you get in touch with your body in a curious, inquiring way, as you start taking steps to improve your health, and as you see your efforts making a difference. You may become more accepting of yourself, less focused on your limitations, and more grateful for what your body can do. At the same time, as a spiritual tradition that seeks to connect you with the divine, yoga can help you recognize that you're more than just your body, which is particularly valuable when you have physical challenges.
Best and most basic of all, yoga can help you learn to enjoy movement again, says Niika Quistgaard, a clinical Ayurveda specialist in western New Jersey. Diagnosed with fibromyalgia eight years ago, Quistgaard knows what it means to be miserable in your own body. "That's one reason my classes go beyond the traditional asanas," she says. "I include shoulder rolls, self-massage, and other juicy, exploratory, pleasurable movements that help people enjoy the experience." While many of her students come to yoga "to fix something," she says, "I like to emphasize that we're already completely whole, and we can enjoy ourselves even when everything isn't physically perfect. It comes down to loving ourselves just as we are, which brings its own healing."
CALL AROUND Contact local yoga studios, wellness centers, and even churches and YMCAs. Classes designed for people with specific health conditions are increasingly common. In addition, classes labeled "Gentle Yoga," "Yoga for Seniors," or "Yoga Therapy" may be appropriate and are likely to include students with a wide range of physical issues.
START YOUR OWN
If you can't find a suitable class, ask local studios whether any of their teachers are qualified to teach special-needs students. If a studio receives enough such requests, it may create a class; if not, you may find an instructor willing to offer private lessons to you or to a group you create.
The International Association of Yoga Therapists lists members at www.iayt.org (or call 928-541-0004). Teachers trained in Integrative Yoga Therapy can be found at www.iytyogatherapy.com. A Web search can yield teachers trained in Iyengar Yoga and Viniyoga, noted for adapting practice to people with health concerns. Kripalu Yoga also offers teacher trainings on working with special-needs students.
DO YOUR HOMEWORK
Whether checking out a publicly offered class or considering private instruction, ask your prospective teachers questions about their training and experience. Have they had extensive training and been teaching for at least three or four years? Generally, the longer they've been practicing and teaching, the better. It's also useful if they've had special training in therapeutic yoga. Have they worked with someone in your condition? Such experience is a plus, but not a necessity. Your comfort, rapport, and communication with the teacher may be just as important.
TALK TO YOUR DOCTORS
Ask your health care providers if there are any precautions you should take in your yoga practice, and communicate these to your teachers.
BREATH IS THE KEY TO YOGA,says Swami Sarvaananda, who teaches at the Integral Yoga ashram in Buckingham, Virginia. Full, even breathing is especially valuable for people with limited mobility, who often have chronically shallow breathing because they sit so much and tend to slump. A technique called Deergha Swaasam (Three-Part Breath) can help. At first, practice it for just a minute, then gradually build to 5 minutes.
Relax and exhale completely, imagining that you're releasing all the tensions and impurities from your body.
Inhale deeply through the nose in three stages: First, fill the lower lungs so the belly swells like a balloon, then the middle lungs, and finally the upper lungs.
Exhale though the nose in reverse order, emptying the upper lungs first, then the middle lungs, and finally the lower lungs.
Carol Krucoff, a yoga teacher and journalist in Chapel Hill, North Carolina, is coauthor, with her husband, Mitchell Krucoff, M.D., of Healing Moves: How to Cure, Relieve, and Prevent Common Ailments with Exercise (Writers' Collective, 2004), www.healingmoves.com.
Find helpful resources on how yoga can help one overcome physical challenges in our Online Extra archives.